Situation Report: Nipah Virus Outbreak in India

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Nipah Virus Outbreak Reported in India

The Indian Ministry of Health and Family Welfare reported six laboratory-confirmed Nipah virus cases between September 12-15, 2023 in the Southern Indian state of Kerala, two of which were fatal.

The source of infection in the first case is unknown and under investigation. The other five patients were close contacts of the index case, including two family members and contacts at the hospital where the first patient was treated. There have not been any new cases detected since September 15.

Nipah virus outbreaks have been recorded almost annually in parts of Southeast Asia, primarily in Bangladesh and India. This recent outbreak is the sixth in India since 2001. Previous outbreaks globally have had case fatality rates ranging between 40 and 75 percent.

How Nipah Virus Spreads

Nipah virus infection is caused by a virus carried by fruit bats, part of the Henipavirus genus, which also includes the equine Hendra virus. The virus can spread to people through the consumption of raw date palm sap and fruit that has been contaminated with bat secretions such as saliva or urine. Transmission can also occur through direct contact with an infected animal or bodily fluids.

Person-to-person spread can occur through close contact with a person infected with Nipah virus or their bodily fluids, including nasal or respiratory droplets, urine, and blood.

Clinical Care Guidance

The clinical presentation of Nipah virus infection can range from a mild respiratory infection to fatal encephalitis. However, because early symptoms may be non-specific, health care workers should implement a symptom and travel screen to identify potential infections.

While there are currently no licensed treatments available for Nipah virus infection, the monoclonal antibody m102.4 has shown promise in neutralizing Henipaviruses, and has been employed under compassionate use protocols for post-exposure prophylaxis for Hendra virus. Additionally, the antivirals ribavirin and remdesivir have also been used in outbreaks with mixed results. Preventative vaccines remain a high priority for development.

Health care workers should follow strict infection prevention and control measures, including the use of appropriate personal protective equipment to prevent nosocomial infections.

What frontline health care workers need to know about Nipah virus, including transmission, symptoms, testing, and clinical care for patients.